Reasons for Surgical Delay in HIP Fracture: What Can We Do From the Emergency Room?

Purpose: To identify the causes of surgical delay in patients with hip fracture, as recognized in the Emergency Department, and to assess their impact on mortality and hospital length of stay. Methods: A retrospective longitudinal study was conducted in a tertiary care Spanish hospital between January and June 2023, including 182 patients aged 65 years or older with hip fracture (76.9% women; mean age 836 ± 7.6 years). The reasons for surgical delay were analyzed, along with hospital length of stay and mortality during hospitalization and 10 months post-discharge. Results: Dementia was present in 41.2% of cases, and the mean Barthel Index was 75.4 points. The median time to surgery was 4 days (IQR: 3-6). Surgery was performed within 72 hours in 41.8% of patients. The most frequent causes of surgical delay were admission during weekends or holidays (90.6%), lack of operating room availability (19.8%), severe renal failure (31.1%), severe infection (24.6%), neurological instability (23.6%), antiplatelet therapy (21.7%), and absence of accompanying family members (16%). Overall mortality was 18.8%. In multivariate analysis, patients operated within 72 hours showed no significant difference in mortality. However, those operated after 72 hours had a significantly longer hospital stay. Conclusions: Surgical delay in hip fractures is influenced by clinical, social, and institutional factors. Familiarity with clinical practice guidelines may help reduce avoidable delays and improve overall hospital length of stay.